Fixing the Behavioral Health Crisis on Our Streets

London Breed
5 min readOct 2, 2019


Every day on our streets there are people who are facing a combination of homelessness, mental illness, and addiction. Each of these conditions is challenging alone, but when experienced at the same time it creates a downward spiral that makes it even more difficult for the person to get treated and housed.

This is not an easy issue and it won’t be solved overnight, but that shouldn’t stop us from taking action now to address the problem. We need a coordinated, citywide approach to make sure that everyone in San Francisco is sheltered and has access to the care they need.

Reforming San Francisco’s Behavioral Health System

Mayor Breed with Dr. Grant Colfax and Dr. Anton Nigusse Bland, the newly appointed Director of Mental Health Reform.

It is no secret that for too long our City’s behavioral health system was in need of serious changes. That’s why in April, I hired Dr. Anton Nigusse Bland to serve as Director of Mental Health Reform at the Department of Public Health. In that role, he’s studying
San Francisco’s approach to behavioral health care and making recommendations on how to improve where we’re falling short. The Department of Public Health is here to serve our City and make sure that people — especially those who are indigent and uninsured — get the medical attention and care that they need in a high-quality, safe, and healing environment. We want to make sure DPH is serving the people that are in the most in need of services.

That’s where my new initiative comes in. The goal is to provide vulnerable residents with intensive services and coordinated treatment to get them off the street and into shelter.

So far, Dr. Nigusse Bland has identified 4,000 residents who are experiencing homelessness and behavioral health crises.

Here’s what we now know about them:

  • 41% are high users of urgent and emergent psychiatric services. This is compared to just 15% of the overall homeless population who are high users of these services.
  • 95% suffer from alcohol use disorder.
  • 35% are African American — despite the fact that African Americans make up just 5% of the overall City population.

Of the 4,000 people, there are 230 people who are most acutely vulnerable. The Initiative will begin by providing targeted help to those 230 people, while also making system-wide changes that will help the entire population of 4,000.

We need a coordinated, citywide approach to address this issues.
Here are the initial steps we’re taking:

  • Strengthening the City’s conservatorship laws, which now allow the City to compel individuals who are not capable of caring for themselves due to severe mental health and addiction into treatment. As a result of Senator Scott Wiener’s SB 1045 and SB40 legislation, it’s estimated that the City will now be able to conserve roughly 100 more people than before.
  • Connecting the 230 most vulnerable people with care coordinators and assess each person’s health needs. DPH will then create and implement individualized plans to help each person get the care they need.
  • Streamlining housing and healthcare. Multiple City departments are working together to make it more straightforward for people to get connected to shelter and permanent supportive housing. The Departments will assign each person a care coordinator, create individual street-to-home plans, and provide access to treatment slots, disability services, housing navigation services and benefits.
  • Expanding the hours of the Behavioral Health Access Center (BHAC), which is as centralized location for drop-in behavioral health care services, and providing on-call transportation so people can get connected to services. Starting in 2020, the BHAC will be open 65 hours per week, up from 40 hours per week. BHAC staff triage and assess clients’ needs, help them enroll in benefits such as Medi-Cal, find placements in treatment programs, and connect clients to other services like medical screenings and primary care.
  • Partnering with Tipping Point Community to open 15 new Hummingbird psychiatric respite beds. Hummingbird beds will primarily serve homeless individuals who may be thinking about entering into treatment or care settings, but have not yet enrolled in these voluntary services.
  • Creating a real-time inventory of treatment beds. This will allow potential clients and service providers to search for availability of
    San Francisco’s 350 short-term residential treatment beds, which people can request for themselves when they are ready for care. The new inventory will be available online in November, and DPH is also working on a new comprehensive bed management tool for the entire behavioral health system.
  • Investing $50 million to support the expansion of behavioral health and other services. This funding will support over 100 additional behavioral health treatment and recover beds, bringing the total number of behavioral beds that I’ve funded since taking office to over 200.
  • Stabilizing existing residential care facilities by increasing subsidies for providers. These facilities, also known as Board and Care facilities, provide both short- and long-term placements for people with behavioral health challenges, including individuals who are conserved or have exited conservatorship. We’re also exploring options to open new Board and Care beds and acquire facilities that are at risk of closing.

We also know that drug dealing is a serious problem that has terrible impacts on our neighborhoods and quality of life. Our Police Department is taking action and making arrests, but we need partners in the District Attorney’s Office and the courts to stop the continued cycle of dealers getting arrested and then constantly released back out on our street.

In the coming months, Dr. Nigusse Bland will release a comprehensive report, assessing the needs of the behavioral health system and recommending reforms to improve the system. This report will be a roadmap for DPH as they work to serve the 4,000 people who desperately need help.

We need to focus on resources on the people who are most in need and who use the highest amount of City and non-profit resources. By doing so, we can get them off the streets and into the treatment and housing they need.
These important initial steps are just the beginning of a complete reform of San Francisco’s behavioral health system, which is critical to meeting the crisis on our streets.



London Breed

45th Mayor of the City and County of San Francisco